Functional and oncological outcomes of 3D clampless sutureless laparoscopic partial nephrectomy for renal tumors with low nephrometry score.

BACKGROUND Renal cell carcinoma still represents 2-3% of all tumors but its mortality is decreased in the last decades due to the early detection of small masses and to the innovative surgical techniques. The aim of our study is to evaluate safety and feasibility of clampless and sutureless laparoscopic partial nephrectomy (CSLPN) in terms of intra- and postoperative functional results, complication rate and oncological outcome. METHODS We evaluated patients undergoing CSLPN between July 2013 and December 2019. Inclusion criteria where single, organ confined tumor with size ≤ 4 cm, intraprenchymal depth ≤ 1.5 cm, RENAL nephrometry score between 4 and 6 and no close contact with the collecting system. RESULTS Overall 62 patients underwent CSLPN. Mean operative time was 105 minutes, mean intraoperative blood loss was 165 ml. Mean drain time and hospital stay were respectively 2.5 and 4.2 days. Mean 24 hours Hb decrease was 2.5 g/dl. No significative variations are described in pre- and postoperative renal function. 12 patients had postoperative complications. At a median follow-up of 38.5 months all the patients are alive and disease free. CONCLUSIONS Different techniques has been proposed to reduce WIT. In our experience we found many benefits in an off-clamp procedure: it gives an ischemiarelated advantage, reduces the overall operating time, eliminates the risks associated with the isolation of hilar vassels. In conclusion CSLPN is a safe and effective procedure for selected renal masses; it doesn't increase complication rate and offers excellent functional and oncological outcomes.